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Cited by 49Cardiovascular Syncope and Autonomic DisordersVestibular and auditory disordersBalance, Gait, and Falls Prevention

Vasovagal syncope in the older person: differences in presentation between older and younger patients

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Duncan, G. W., Tan, M. P., Newton, J. L., Reeve, P., Parry, S. W.·2010·Age and Ageing
DOI 10.1093/ageing/afq039
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Abstract

Background vasovagal syncope (VVS) has been diagnosed with increasing frequency in older people since the description of the head-up tilt table test (HUTT). There is, however, a paucity of research describing the clinical features of VVS in this group. To address this issue, we investigated the age distribution and differences in clinical characteristics associated with age in patients diagnosed with VVS by HUTT at our tertiary referral centre. Methods 1,060 consecutive patients with tilt-positive VVS were identified from a prospective database containing the demographic and clinical information of individuals assessed in our unit over a 10-year period. VVS was diagnosed with appropriate haemodynamic changes during HUTT and accompanying symptom reproduction. Results we found a bimodal age distribution with a small peak at 20-29 years and a larger peak at 70-79 years. Patients aged > or =60 years were less likely to report total loss of consciousness [odds ratio (OR) 0.50, 95% confidence interval (CI) = 0.38-0.64], near loss of consciousness (OR 0.53, 95% CI = 0.40-0.70) or palpitations (OR 0.45, 95% CI = 0.28-0.72) and more likely to present with unexplained falls (OR 2.33, 95% CI = 1.36-4.32). The typical provoking factors of prolonged standing (OR 0.55, 95% CI = 0.40-0.72), posture change (OR 0.61, 95% CI = 0.46-0.82) and hot environments (OR 0.57, 95% CI = 0.42-0.78) were also less common in older patients. Conclusion in our large study population, VVS was more common in o…

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Crossref · 10.1093/ageing/afq039

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  • The incidence of syncope in older adults is high.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [673]

  • The differential diagnosis of syncope in older adults is broad.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [673]

  • The diagnosis of syncope in older adults is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [673]

  • Secondary morbidity from syncope in older adults is high because of comorbidities, physical injury, and frailty.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [673]

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Authors
Duncan, G. W., Tan, M. P., Newton, J. L., Reeve, P., & Parry, S. W.
Affiliations
Royal Victoria Infirmary (GB)
ORCID
Venue
Age and Ageing
Publisher
Oxford University Press (OUP)
Published
2010-05-05
Volume
39
Issue
4
Pages
465-470
ISSN
  • 0002-0729 (ISSN-L)
  • 1468-2834
DOI
10.1093/ageing/afq039
OpenAlex
W2128793913
Cited by
49
References
27
Citations by year
2025: 2 · 2024: 2 · 2023: 6 · 2022: 6 · 2021: 2 · 2020: 2 · 2019: 3 · 2017: 7 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 6 · 2012: 4
FWCI
4.07
Type
journal article
Language
en
Open access
Locations
  • Age and Ageing (publishedVersion)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Funders
National Institute for Health and Care Research
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Keywords
vasovagal syncope, older adults, age distribution, clinical features, tilt table test, unexplained falls, loss of consciousness, precipitating factors, prolonged standing, posture change, hot environment, palpitations
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Hemodynamics, Humans, Male, Middle Aged, Posture, Prospective Studies, Unconsciousness, Geriatric Assessment, Tilt-Table Test, Syncope, Vasovagal, Young Adult

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